Trainee colonoscopists fulfil quality standards for the detection of adenomatous polyps

Abstract

BackgroundThe detection of adenomatous lesions is a major indicator for quality and competence in colonoscopy. Little is known about adenoma detection rates (ADR) of endoscopy trainees. The aim of our study was to investigate the performance of trainee colonoscopists in detecting adenomas and to depict the shape of adenoma detection learning curves during apprenticeship.MethodsWe retrospectively investigated a prospectively maintained database of a single tertiary referral center to reveal colonoscopies performed by trainee endoscopists during 2001 and 2013. Colonoscopy reports were chronologically retrieved and separately analyzed for each trainee. Using cumulative curves, courses of trainee’s Adenoma detection rates (ADR) during apprenticeship were displayed. Additionally, procedural data including cecal intubation rate and occurrence of complications were assessed.ResultsWe retrospectively analyzed 4354 colonoscopies conducted by 10 trainee endoscopists (TE). A median number of 371 investigations were performed by each apprentice. Group ADR was 23%. No significant difference between aggregated ADRs at the beginning (23%) and at the end (22%) of apprenticeship could be determined (p = 0.70). However, individual learning curves showed considerable different slopes. Personal ADR values ranged between 17% and 31%. Overall cecum intubation rate was 99.0 %. Complication rates were low and fulfilled quality requirements recommended in guidelines.ConclusionFrom the beginning of education, trainee colonoscopists are capable to provide high-quality investigations considering the detection of adenomas as a benchmark quality indicator. Nevertheless, performance differs markedly between investigators. Therefore, individual detection rates should be reviewed regularly to reveal further need for training.

Endocuff-Assisted versus Cap-Assisted Colonoscopy Performed by Trainees: A Retrospective Study

“…7 ADR of trainees is generally lower than that of experts 23,24 and has been reported to be 23%-36%. [25][26][27] Although a previous study reported no significant difference in ADR between EAC and CAC, 19 differences between these procedures when performed by trainees remain unclear. In the present study, the cecal intubation rate and time were similar between the two groups.…”

“…In the present study, even though trainees were experienced in performing colonoscopies, ADR and MAP were relatively higher in both the EAC and CAC groups compared to the results of previous studies. [25][26][27] However, we did not investigate ADR of CC, so it is unclear whether ADR improved compared to CC. Furthermore, because we did not investigate the efficacy of EAC and CAC performed by experts, differences between trainees and experts remain unclear.…”

Teaching Basic Colonoscopy Skills: Quality and Safety Standards Can Be Fulfilled in an Outpatient University Center

“…To ensure the quality of endoscopic examination, it is important to adopt indicators associated with increased accuracy and reduced complications (10,11) . Recent studies have shown that endoscopy fellows can perform the exam effectively and safely (12) . However, little is known about the performance of surgical residents without prior knowledge of endoscopic techniques.…”

Magnetic endoscope imaging for routine colonoscopy: impact on propofol dosage and patient safety – a randomized trial

“…In one study on trainee colonoscopists, a number of 275 colonoscopies was required until an 85 % cecal intubation rate was reached [34]. In another trial that analyzed 250 consecutive investigations performed by trainees, adenoma detection was high enough to fulfill the currents standards [35]. It is quite clear that 300 investigations are not sufficient to turn a trainee into an expert; however, we believe that this threshold can be considered adequate as a benchmark of competence in this case.…”